This population-based cohort study by Mantel et al. «Mantel Ä, Hirschberg AL, Stephansson O. Associatio...»1 included all singleton births included in the Swedish Medical Birth Register from January 1, 2003, to December 31, 2014. A total of 7542 women with diagnosed eating disorders were compared with 1 225 321 women without eating disorders. Statistical analysis was performed from January 1, 2018, to April 30, 2019. Via linkage with the national patient register, women with eating disorders were identified and compared with women free of any eating disorder. Eating disorders were further stratified into active or previous disease based on last time of diagnosis.
The risk of adverse pregnancy outcomes (hyperemesis, anemia, preeclampsia, and antepartum hemorrhage), the mode of delivery (cesarean delivery, vaginal delivery, or instrumental vaginal delivery), and the neonatal outcomes (preterm birth, small and large sizes for gestational age, Apgar score <7 at 5 minutes, and microcephaly) were calculated using Poisson regression analysis to estimate risk ratios (RRs). Models were adjusted for age, parity, smoking status, and birth year.
There were 2769 women with anorexia nervosa (mean [SD] age, 29.4 [5.3] years), 1378 women with bulimia nervosa (mean [SD] age, 30.2 [4.9] years), and 3395 women with an eating disorder not otherwise specified (EDNOS; mean [SD] age, 28.9 [5.3] years), and they were analyzed and compared with 1 225 321 women without eating disorders (mean [SD] age, 30.3 [5.2] years). All subtypes of maternal eating disorders were associated with an approximately 2-fold increased risk of hyperemesis during pregnancy (anorexia nervosa: RR, 2.1 [95 % CI, 1.8-2.5]; bulimia nervosa: RR, 2.1 [95 % CI, 1.6-2.7]; EDNOS: RR, 2.6 [95 % CI, 2.3-3.0]). The risk of anemia during pregnancy was doubled for women with active anorexia nervosa (RR, 2.1 [95 % CI, 1.3-3.2]) or EDNOS (RR, 2.1 [95 % CI, 1.5-2.8]). Maternal anorexia nervosa was associated with an increased risk of antepartum hemorrhage (RR, 1.6 [95 % CI, 1.2-2.1]), which was more pronounced in active vs previous disease. Women with anorexia nervosa (RR, 0.7 [95 % CI, 0.6-0.9]) and women with EDNOS (RR, 0.8 [95 % CI, 0.7-1.0]) were at decreased risk of instrumental-assisted vaginal births; otherwise, there were no major differences in mode of delivery. Women with eating disorders, all subtypes, were at increased risk of a preterm birth (anorexia nervosa: RR, 1.6 [95 % CI, 1.4-1.8]; bulimia nervosa: RR, 1.3 [95 % CI, 1.0-1.6]; and EDNOS: RR, 1.4 [95 % CI, 1.2-1.6]) and of delivering neonates with microcephaly (anorexia nervosa: RR, 1.9 [95 % CI, 1.5-2.4]; bulimia nervosa: RR, 1.6 [95 % CI, 1.1-2.4]; EDNOS: RR, 1.4 [95 % CI, 1.2-1.9]).
The findings of this study suggest that women with active or previous eating disorders, regardless of subtype, are at increased risk of adverse pregnancy and neonatal outcomes and may need increased surveillance in antenatal and delivery care.
In this register-based case-control follow-up study by Linna et al. «Linna MS, Raevuori A, Haukka J, ym. Pregnancy, obs...»2, female patients (n = 2257) who were treated at the Eating Disorder Clinic of Helsinki University Central Hospital from 1995-2010 were compared with unexposed women from the population (n = 9028). Register-based information on pregnancy, obstetric, and perinatal health outcomes and complications were acquired for all singleton births during the follow-up period among women with broad anorexia nervosa (AN; n = 302 births), broad bulimia nervosa (BN; n = 724), binge eating disorder (BED; n = 52), and unexposed women (n = 6319).
Women with AN and BN gave birth to babies with lower birthweight compared with unexposed women (AN: mean, 3302 ± 562 g; adjusted p<0.001, BN: mean, 3464 ±563 g; adjusted p = 0,037, unexposed women: mean, 3520 ± 539 g), but the opposite was observed in women with BED (mean, 3812 ± 519 g; adjusted p<0.001).
Maternal AN was related to anemia (3.97 % in AN vs 1.54 % in unexposed women, adjusted OR 2.39, 95 % CI 1.20-4.76), slow fetal growth (4.64 % in AN vs 1.93 % in unexposed women, adjusted OR 2.59, 95 % CI 1.43-4.71), premature contractions (3.26 % in AN vs 1.52 % in unexposed women, adjusted OR 2.31, 95 % CI 1.05-5.11), short duration of the first stage of labor, very premature birth (0.99 % in AN vs 0.29 % in unexposed women, adjusted OR 4.59, 95 % CI 1.25-16.87), small for gestational age (4.30 % in AN vs. 2.10 % in unexposed women, adjusted OR 2.20, 95 % CI 1.23-3.93), low birthweight (6.31 % in AN vs. 3.19 % in unexposed women, adjusted OR 2.16, 95 % CI 1.30-3.58), and perinatal death (0.99 % in AN vs 0.33 % in unexposed women, adjusted OR 4.06, 95 % CI 1.15-14.35). Increased odds of premature contractions (3.25 % in BN vs 1.52 % in unexposed women, adjusted OR 2.20, 95 % CI 1.17-4.14), resuscitation of the neonate (2.07 % in BN vs 0.92 % in unexposed women, adjusted OR 2.12, 95 % CI 1-18-3.79), and very low Apgar score at 1 minute (2.64 % in BN vs 1.27 % in unexposed women, adjusted OR 2.31, 95 % CI 1.34-3.98) were observed in mothers with BN. BED was associated positively with maternal hypertension (22,22 % in BED vs 2.24 % in unexposed women, adjusted OR 13.29, 95 % CI 4.03-43.81), long duration of the first and second stage of labor, and birth of large-for-gestational-age infants (9.62 % in BED vs. 2.45 % in unexposed women, adjusted OR 4.32, 95 % CI 1.64-11.36).
The study concludes thateating disorders appear to be associated with several adverse perinatal outcomes, particularly in offspring. The authors recommend close monitoring of pregnant women with either a past or current eating disorder and that attention should be paid to children who are born to these mothers.
This study by Bulik et al. «Bulik CM, Von Holle A, Siega-Riz AM, ym. Birth out...»3 explored the impact of eating disorders on birth outcomes in the Norwegian Mother and Child Cohort Study. Of 35,929 pregnant women, 35 reported anorexia nervosa (AN), 304 bulimia nervosa (BN), 1,812 binge eating disorder (BED), and 36 EDNOS-purging type (EDNOS-P) in the six months before or during pregnancy. The referent comprised 33,742 women with no eating disorder.
Pre-pregnancy body mass index (BMI) was lower in AN and higher in BED than the referent. AN, BN, and BED mothers reported greater gestational weight gain, and smoking was elevated in all eating disorder groups. BED mothers had higher birth weight babies, lower risk of small for gestational age, and higher risk of large for gestational age and cesarean section than the referent. Pre-pregnancy BMI and gestational weight gain attenuated the effects.
The authors conclude that BED influences birth outcomes either directly or via higher maternal weight and gestational weight gain. The absence of differences in AN and EDNOS-P may reflect small numbers and lesser severity in population samples. Adequate gestational weight gain in AN may mitigate against adverse birth outcomes. Detecting eating disorders in pregnancy could identify modifiable factors (e.g., high gestational weight gain, binge eating, and smoking) that influence birth outcomes.
This retrospective study by Pasternak et al. «Pasternak Y, Weintraub AY, Shoham-Vardi I, ym. Obs...»4 investigated whether women with a history of eating disorders have an increased risk for adverse obstetric and perinatal outcomes.
Deliveries occurred during the years 1988-2009 in a tertiary medical center. Women lacking prenatal care and with multiple gestations were excluded from the study.
During the study period, of 117,875 singleton deliveries, 122 (0.1 %) occurred in patients with eating disorders. Eating disorders were significantly associated with fertility treatments (5.7 % vs. 2.8 %, p = 0.047), intrauterine growth restriction (7.4 % vs. 2.3 %, p<0.001), term low birth weight (<2500 g) (7.4 % vs. 2.8 %, p = 0.002), preterm delivery (15.6 % vs. 7.5 %, p = 0.002), and cesarean delivery (25.4 % vs. 15.0 %, p = 0.001). Using multivariable analyses, low birth weight (OR 2.5, 95 % CI 1.3-5.0), preterm delivery (OR 2.2, 95 % CI 1.4-3.6), and cesarean section (OR 1.9, 95 % CI 1.3-2.9) were significantly associated with eating disorders.
Eating disorders are associated with increased risk of adverse pregnancy outcomes. Accordingly, careful surveillance is needed for early detection of possible complications.